Objectives: Mechanical thrombectomy significantly improves outcomes in patients with acute ischemic stroke due to large vessel occlusion (LVO). However, in many low- and middle-income countries (LMICs), access to thrombectomy is hindered by limited imaging infrastructure. Computed tomography (CT) angiography (CTA), the standard for LVO detection, is often unaffordable or unavailable. In this context, contrast-enhanced CT (CECT) brain imaging may offer a viable alternative. Our objective was to evaluate the diagnostic accuracy of CECT brain in detecting LVO and its utility in guiding mechanical thrombectomy in a resource-constrained setting. Materials and Methods: We retrospectively analyzed 25 patients who underwent mechanical thrombectomy based on LVO identified on CECT. Scans were acquired 15–16 s after injecting 20 mL of iodinated contrast. LVO presence was confirmed by digital subtraction angiography immediately before thrombectomy. Patients with no LVO on CECT with follow-up CTA/magnetic resonance angiography were included to assess diagnostic accuracy. Clinical outcomes were evaluated using the modified Rankin Scale (mRS) at discharge. Results: CECT showed high diagnostic accuracy with a sensitivity of 96.0%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 96.2%. Favorable clinical outcomes (mRS 0–2) were achieved in 68% of patients. Successful recanalization - thrombolysis in cerebral infarction 3 and higher pre-procedure Alberta Stroke Programme Early CT scores were significantly associated with better outcomes. Conclusion: CECT brain is a reliable, accessible, and low-cost alternative to CTA for detecting LVO in resource-limited settings. It enables rapid identification of thrombectomy candidates, facilitating timely intervention and improved outcomes in LMICs.
Yadav et al. (Thu,) studied this question.